Collaboration: Emerging From Below

The January issue of Health Affairs focuses on the benefits of “communication-and-resolution programs” (CRPs), designed to facilitate the communication between healthcare providers and patients and families following unforeseen outcomes, including errors.

The January issue of Health Affairs focuses on the benefits of “communication-and-resolution programs” (CRPs), designed to facilitate the communication between healthcare providers and patients and families following unforeseen outcomes, including errors. Intended to decrease the potentially adversarial nature of these conversations, the programs include formal training and support for those involved in the event.There is early evidence that investment in training like this can be associated with fewer malpractice suits and improved patient safety.

While there is emerging evidence to support CRPs, they’ll most likely be lengthy, expensive propositions. Work that Plexus is involved in currently suggests another way. STEP (Support Teaching Effectiveness Project) is bringing together educators who have volunteered from two middle schools in the Long Beach Unified School District to discover how they and some of their peers are able to continually improve their teaching effectiveness over the arc of their careers. Plexus is utilizing an Adaptive Positive Deviance (APD) framework to facilitate this work.

In an early meeting at Lindbergh Middle School, involved educators, realizing they were going to be discovering the pathway towards these positively deviant behaviors without external expertise, decided they would benefit from a dedicated space for collaborating and learning about effective teaching practices. They rapidly converted a vacant classroom into such a space, held an open house inviting all of their peers to engage in the discovery process, and began holding regular meetings there. Less than two weeks later, a group of educators who weren’t formally a part of this initiative were found sitting in the collaboration space, discussing how to better integrate student feedback of teacher performance into improved teaching.

People innately want to communicate and collaborate. Many organizations and their leaders have created incentives and barriers that inhibit relationships and foster a “me-first” attitude. The APD approach helps these interactions occur naturally, driven by curiosity, companionship, and purpose. Leaders should help people identify something that’s important to them, give them opportunities to be with and relate to each other frequently, and collaborative work will occur from the bottom-up. How much more effective and less expensive might an APD approach be than formal, designed from the top programs in pursuit of the same goal? If our organizational leadership creates the conditions, help the people working on the problem make sense of what’s going on, and then gets out of the way, this will allow collaboration and its consequences to emerge. The collaboration room in Lindbergh Middle School and what’s happening in it suggests those of us in leadership roles would be amazed at what can happen, driven by the collaborators themselves.